HL7 Presentation v2
44
An Introduction to HL7 Philip Firth IM&T Strategy Implementation Manager Wrightington, Wigan & Leigh NHS Trust 01942 773702 [email protected]
Transcript of HL7 Presentation v2
An Introduction to HL7
Philip Firth
IM&T Strategy Implementation ManagerWrightington, Wigan & Leigh NHS Trust
01942 773702
My background
NHS IT Manager Leading on the implementation of EPR at
Wrightington, Wigan & Leigh NHS Trust ‘Best-of-breed’ strategy – a lot of systems
integration Good understanding of HL7 BUT – not an expert, especially in HL7v3
History - Healthcare Standards
1988 ASTM E.1238 Lab messages 1988 HL7 Version 2.0 1995 CEN ENV 1613 Lab messages 1997 CEN CR 12587 Methodology 2000 CEN ENV 13606 EHR comms 2002 HL7 Version 3 (3rd Ballot) 2002 HL7 version 3 adopted by NPfIT
HL7 version 2
Why HL7 Version 2
UK specific version of HL7v2 Wide international industry and user support Extensive implementation base Extensive skill base Non-proprietary
Key issue Not comprehensive (breadth of scope – does not
cover all healthcare interoperability)
A typical patient admit message will include the following fields:- Source and destination MSH (Message header) segment Patient ID, demographics PID (Patient ID) segment Message type EVN (Event Type) segment Admit date and time EVN (Event Type) segment Ward PV1 (Patient Visit) segment Consultant PV1 (Patient Visit) segment
Example message: patient admission
Patient William A. Jones, III was admitted on July 18, 1988 at 11:23 a.m. by doctor Sidney J. Lebauer (#004777) for surgery (SUR). He has been assigned to room 2012, bed 01 on nursing unit 2000.
The message was sent from system ADT1 at the MCM site to system LABADT, also at the MCM site, on the same date as the admission took place, but three minutes after the admit.
MSH|^~\&|ADT1|MCM|LABADT|MCM|198808181126|SECURITY|ADT ̂A01|MSG00001 |P|2.3.1|<cr>
EVN|A01|198808181123||<cr> PID|1||PATID1234^5^M11^ADT1^MR^MCM~123456789^^^USSSA^SS||JONES^WILLIAM^A^III||19610615|M ||C|1200 N ELM STREET^^GREENSBORO^NC^27401‑1020|GL|(91 9)379‑1212|(919)271‑3434||S||
PATID12345001^2^M10^ADT1^AN^A|123456789|9 87654^NC|<cr> NK1|1|JONES^BARBARA^K|WI^WIFE||||NK^NEXT OF KIN<cr>
PV1|1|I|2000^2012^01||||004777^LEBAUER^SIDNEY^J.|||SUR|| ||ADM|A0 |<cr>
Example message: patient admission
Systems integration approach
In-house development– supplier community often does not appreciate
the complexity of the NHS
Use messaging / data exchange standards wherever possible– Web services– XML– HL7
Integration architecture
CASE STUDY 1:
Developing an interface to:
(a) send pathology results from the MasterLab system
and
(b) present them to clinicians in the EPR system
HL7v2 pathology interface in Wigan
MasterLab pathology system screen
HL7v2 pathology interface in Wigan
MasterLab pathology HL7 message:
ORU
MSH|^~\&|MLAB||||20030306083246||ORU^R01|X675|P|2.3PID|1||999999^^^^PAS~LK301079^^^^NHS||NAME^FORENAME^^^||19231231|M|||99 ACACIA AVENUE^ABRAM^WIGAN^^|||||ZMP|^^NAT^^^L|^^LZPV|IP|ICUR^^^MLAB&RAEI&L^^W|&ALB^BLOWER^A.L.^^^Mr.|ICUR^^^MLAB&RAEI&L^^W|&ALB^BLOWER^A.L.^^^OBR|1||5802432^CCMLAB|CC_RICUP^Intensive Care Profile^L^^^L|||20030306|||||||200303060730||&ALB^BLOWER^A.L.^^^OBX|1|ST|CC_TONA^Sodium^L||136|mmol/L|135-145|N|||FOBX|2|ST|CC_TOK^Potassium^L||4.4|mmol/L|3.5-5.3|N|||FOBX|3|ST|CC_TOCL^Chloride^L||106|mmol/L|95-106||||FOBX|4|ST|CC_TOBIC^Bicarbonate^L||18|mmol/L|22-34|L|||FOBX|5|ST|CC_TOBUN^Urea^L||29.9|mmol/L|1.7-9.0|H|||FOBX|6|ST|CC_TOCRT^Creatinine^L||282|umol/L|60-140|H|||FOBX|7|ST|CC_TAGAP^Anion Gap^L||16|mmol/L|8-20|N|||FOBX|8|ST|CC_TOCA^Calcium^L||1.96|mmol/L|2.15-2.60|L|||FOBX|9|ST|CC_TOCAF^Calcium corrected for Alb conc^L||2.41|mmol/L|2.05-2.60|N|||FOBX|10|ST|CC_TOINP^Phosphate^L||2.27|mmol/L|0.8-1.45|H|||FOBX|11|ST|CC_TOTP^Total Protein^L||46|g/L|60-82|L|||FOBX|12|ST|CC_TOALB^Albumin^L||22|g/L|34-48|L|||F
HL7v2 pathology interface in Wigan
Use XSLT to convert HL7 message to XML
HL7v2 pathology interface in Wigan
Use XML Schema to validate XML message
HL7v2 pathology interface in Wigan
View XML pathology result in EPR system via a Stylesheet
CASE STUDY 2:
Developing/Refining XML stylesheets to present pathology results in EPR:
(a) Correctly(b) In a user friendly format
Needed to emulate presentation in the MasterLab system
============
Cultures
Sensitivities in a tabular format
Microbiology HL7v2 message
Result sections
============
The stylesheet design evolved bit by bits and was amended on recommendations from Microbiologists:
Here the stylesheet had made some progress but had still not accounted for the need to associate antibiotic sensitivities with organism
(a) Cultures
(b) Sensitivities
Needed to emulate presentation in the MasterLab system
============
Cultures
Sensitivities in a tabular format
Result sections
============
A stylesheet had to developed that was able to distinguish between:
(b) Cultures
(b) Organism
(c) Sensitivities
HL7 version 3
Why HL7 Version 3
Comprehensive (breadth of scope – all healthcare interoperability)
Wide international industry and user support Extensible (future-proof) Conformance-testable Non-proprietary Uses up-to-date industry standards (UML, XML)
Reference Information Model
Overarching RIM to ensure consistent and cohesive message specifications across healthcare requirements
Unique representation of health care domain
35 classes with 181 attributes Descended from six critical backbone classes
(Act, RoleRole, Entity, Participation, ActRelationship, RoleLinkRoleLink)
Role
-classCode
Entity
-classCode
-determinerCode
Participation
-typeCode
Act
-classCode
-moodCode
ActRelationship
-typeCode
scopes0..*0..1
0..*1 10..*
1
0..*
targetsource
1
0..*
0..1 0..*plays
RoleLink
-typeCode
target
1
0..*
source
0..*
1
scopes0..*0..1
plays 0..*0..1 0..*1 0..* 1
1
0..*
source
0..*
1 1
0..* 0..*
1
source target target
RIM Backbone
Core concepts of RIM
Every happening is an Act– Observation, Prescribe, Registration, etc.
Participation defines the context for an Act– Prescriber, Dispenser, Subject,etc.
The participants are RolesRoles– Patient, Practitioner, Pharmacist, etc.
Roles are played by Entities– Person, PCT, Pharmacy, Medical product, etc.
Steps from the RIM to implementable messages
Reference Information Model (RIM)– The source or pattern for all HL7 messages
Refined Message Information Model (RMIM)– A specific model for a set of messages– Derived from the RIM
Hierarchical Message Description (HMD)– Basis of one or more Message Types
Message Types– A fully refined structure capable of being mapped into an
implementable form Implementable Technology Specification (ITS)
– The final step creating an implementable message
Refinement from RIM to Message
Tools: Representation of R-MIMs
R-MIMs are represented– Diagrammatically in Visio– In a Repository in two forms: Access & XML
Visio for diagrams– Use of colour to distinguish RIM base class– Visio extensibility with VBA allows
• Validation of R-MIMs against the RIM repository• Direct saving of R-MIMs in the repository
Tools: Visio for HL7 RMIM Design
Drag and drop Entry Point, Name and identify the R-MIM
Drag and drop classes onto page
Naming of clone classSpecification of structural codes values (e.g. classCode, moodCode etc.)
Drag and connect relationships
Property window allows cardinalities to be specified
PrescribeclassCode*: [1..1] <= SPLYmoodCode*: [1..1] <= ORDstatusCode: CNE [0..*] <= ActStatusactivityTime: [0..1]availabilityTime: [0..1]
PrescriptionItemclassCode*: [1..1] <= SPLYmoodCode*: [1..1] <= ORDcode*: CWE [1..1] <= ActCodetext*: [1..1]effectiveTime: [0..1]availabilityTime: [0..1]quantity: [0..1]
DosageclassCode*: [1..1] <= SBADMmoodCode*: [1..1] <= ORDcode: CWE [0..1] <= ActCodetext: [0..1]activityTime: [0..1]doseQuantity: [0..1]
PersonclassCode*: [1..1] <= PSNdeterminerCode*: [1..1] <= INSTANCEname*: [1..1]birthTime: [0..1]addr*: [1..1]
PersonPractitionerclassCode*: [1..1] <= PSNdeterminerCode*: [1..1] <= INSTANCEname*: [1..1]telecom: [0..*]
1..1agentOrganization*
PharmacyRoleclassCode*: [1..1] <= AGNTid*: [1..1]
1..1patient*PatientclassCode*: [1..1] <= PATid*: [0..1]
1..1agentPerson*
0..1scopingEntityNamePractitionerclassCode*: [1..1] <= AGNTid*: [1..1]
0..* patient
typeCode*: [1..1] <= PATSBJ
Subject
0..* agent
typeCode*: [1..1] <= AUT
Prescriber
0..* agent
typeCode*: [1..1] <= PRF
Dispenser
1..* tgtActName*
typeCode*:
[1..1] <= COMP
Contains
0..* tgtActName
typeCode*: [1..1] <= COMP
RelatedDosage
1..1manufacturedManufacturedMaterial
ManufacturedProductclassCode*: [1..1] <= THER
0..* manufacturedProduct
typeCode*: [1..1] <= CSM
ProductPrescribed
MedicinalProductclassCode*: [1..1] <= MMATdeterminerCode*: [1..1] <= INSTANCEcode: CWE [0..1] <= EntityCodequantity: [0..*]name: [0..*]desc: [0..1]handlingCode: CWE [0..1] <= EntityHandlingformCode: CWE [0..1] <= MaterialFormlotName: [0..1]
PrimaryCareTrustclassCode*: [1..1] <= ORGdeterminerCode*: [1..1] <= INSTANCEid*: [1..1]name*: [1..1]
PharmacyclassCode*: [1..1] <= ORGdeterminerCode*: [1..1] <= INSTANCEid: [0..*]name*: [1..1]addr: [0..1]
Prescription(DEMO_RM000000)
Example only
Tools: View/edit HMD in Rosetree
Create/edit HMD Export specifications
to XML Generate
documentation Generate XML-
Schemas, Generate XSLT-
stylesheets Generate sample
messages
An HL7v3 XML-SchemaRepresentation of content
HL7 Version 3 fragment as raw XML
HL7 Version 3 fragment as in a structured form for technical review
HL7 Version 3 fragment as transformed to a plain text view
HL7 version 3and NPfIT
NHS endorses HL7 Version 3
NHS ISB (March 2002) – Approval for HL7v3 to be the enabling standard for ICRS
Delivering 21st Century IT Support for the NHS (June 2002)
HL7v3 key element of Part 3: OBS1 and OBS2
NHS is sponsoring tool development to further improve the HL7 v3 development process
ICRS Phase 1
HL7v3 will play a key role in establishing
E-Booking Personal Demographics Service (PDS) Personal Spine Information Service (PSIS) Transaction Messaging Spine (TMS)
Clinical Document Architecture Document Markup Standard that specifies
the structure and semantics of clinical documents for the purpose of exchange
Human readable, encoded in XML CDA II (Cleveland Draft) documents derive
their meaning from the RIM and use HL7v3 datatypes
June 2003 - decision by NPfIT to adopt Messaging rather than CDA II for ICRS development
Want to know more about HL7?
Join HL7UK – see www.hl7.org.uk HL7 repository – see www.hl7.org.uk HL7 courses – see www.hl7.org.uk
HL7 Health Level 7 CEN European Standardization of Health Informatics
RIM Reference Information Model R-MIM Refined Message Information Model D-MIM Domain Message Information Model C-MET Common Message Element Type HMD Hierarchical Message Description ITS Implementation Technology Specification CDA Clinical Document Architecture UML Unified Modelling Language
ASTM American Society for Testing and Materials
Acronyms
